HomeMy WebLinkAboutWTR2702286 W-2286 Valle:- Medical Center 1
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Return Address:
City Clerk's Office Gt
City of Renton
200 Mill Avenue South at
Renton,WA 98055-2189
M
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BILL OF SALE Properly Tax Parcel Number. _ R
O Prefect File N'.B9607 i 3 St¢ct In cf r" on t dress
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Rekrente Number(s)of fbcuments_,ccl or released Additional renuence numbers acl on page__ '
Graator(sk Valley MediCal Center Grantee(sl:
trial f 1. City of Renton,a Municipal Corporation _ \
2 �_.',..
The Gnmor,as named above,for,ar�d in considemuon of mutual benefits,hereby grams.hargams,sells and dclrvcrs to �
s to the Grannie,as named above,the following described personal progeny
{t{ y+
"of L.F x,F $1, DI VATFtM91J l
�q$ 4F (,f 1Lr' ill WATkRMAtu l
9" 6A Te ✓ALvE.$
3 (Za' GATE✓H�Vf$
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By this com,q ar.c,Grantor will wartant and defend the sale hereby made unto the Grantee against all and even perwn
nr perwns,sehums.c,cc iawfull)claiming or lu claim the same. This conveyance shall bind the heirs,executors,
administrator and assigns recliner.
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. F,NwITNIES!S� .RF.OF,1 a h�ac W settmy b�anJ and sal the toy and year as written below.
�vuuh� F-1,�_ yZZ�
lNDIYlOWLNDRMO/A
Notary Scat mist be within box STATE OF WASHINGTON )SS
COUNTS'OF KING )
1 wufY that 1 know or have satisfactory cridma
_ signed this irutm ment and
tlm aowleiged d to be his/hvhheir I.and mlu dary act for the uses and purposes
mentioned in the instrument
_ _-._
Notary public in and Gat the State of Washington
Notary
` M appointment — ----—--
Y PPS uPiser—_
Dated:
Iuruss:NrArivn rQWZ-rAfrtiowiF.bcweNs'
Notary Send must Ine within box STATE.OF WASHINGTON )SS
COUNTY OF KING ) '
I certify that 1 know or have Wis6dory evidmae that
_signcd this instrument.on osth_ i
.od.shot hdaArAhey WaaFvtle Wthafiled-accuse die insuunenl and
acknowlsdged it u th.- __ and
-.__�
of — __.
W be the fia ed vo:unwy act of surL
CI perty/pvlies for the use and putposess mentioned in the instrument.
Val Notary
—Pub lic in and for the State of Washington '
al Notary(Print)-- - ---.
V4 My appointment cxpims:__
N Dated:
CON%ORe 7'6T17tM d!'AfIM��tiv! —
Notary Seal must he within box STATE OF WASHINGTON )SS
COUNTY OF KING )
Onthis..__.drof .Ip ,beforc.ncrnoanyappared
--- - -- la me known to
be -of dm coipmdion the:
executed Nc within inWumcnr,aM 11d1hl0wl dge the said Instument ra be the Im.
and voluntary net aM need of said raporauon,for the uses and pmposcs thetein
mentioned,and each on oath stated that hdeht was authorlxed to execute mid
insuumcnt and Uul the sed effused is the corporate sal of said eurponuon.
Notary Pubbc in and(M the State of Washington
Notary(Print)_
My appointment exptrcs _
Dated:
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INDIVIDUAL OFACXNOWLEDGAI£N!
Notary Seal must he within box STATE OF WASHINGTON )SS
COUNTY OF KING )
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I cenify that I know or have satis.actory evidence that
signed this instrument mid
acknowledged it to be his/her/their free and voluntary act for the uses and purposes
mentioned in the instrument
Notary Public in and for the State of Washington
Notary(Print)
My appointment expires:
Dated
REFRES A—ATIFf —U OFACXN0WLEDGMENT
Notary Sal must be within box STATE OF WASHINGTON )SS '.
COUNTY OF KING )
I certify that I know on I.—e satisfactory evidence 1Mt s�.M xAI e
v
M. Inilimcc-l's, signed this instrument,on oath
slated that hdshaYMy wasllabi authorized to execute the instrument and
�acknowt ged it is the s and
' �- '• s H i`,1A lo( nll••.'(k1..1.T. '` to be the free and voluntary act of such .e
- Y Im?".pau`t•• or the th``e''o's`'' urposes mentioned in the instrument r
HNrtair)VjAblic in and for the NUate oj$'Oshington
(� Notary(Print) .. rJ
Tall My appot'�ter texpires:
IN Dared:
Tail
CORPORATE FORM OFACXN'OWLEDGMENT I'
Notary Seal must be within box STATE OF WASHINGTON )SS
COUNTY OF KING )
On this_dry of 19_,before me personally appeared x �
p to me known to `
be of the corpuration that
executed the within inswment,and acknowledge the said instrument to be the free f
and voluntary act and deed of said corporation,for the uses and purposes therein
mentioned.arM each on oath stated that he/she was authorised to acute said s
ins ument and that the seal affixed is the corporate seal of mid corporation.
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Notary Public in and for the State of Washington I
Notary(Print)
My appointment expires:
Dated:
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EXHIBIT "A"
PROJECT CLOSING I4 Final Cost Data
FINAL COST DATA AND INVENTORY and Inventory
SUBJECT: B960743 CITY PROJECT NUMBERS, WIR-
Co-Generation Plant WWP.
vane.. McAicisl renter SWP.
Name of pmfeet TRO.
TED
TO. City of Renton )ROM'. jfilj� lid
icalMan Review Section r Street~
i'aninFJ6uilding/Public Worts Renton . WA 98055
2W Mill Avenue South _
Renton,WA 90D55 DATE: Deromhe. I 19g7
Per the request of the City of Renton,the following information is furnished concerning final costs for improvements
installed for the above referenced Project.
WATEI.SYSTEM CONSTRUCTION COSTS'
Length Six Type
64 LF.of B ' _III WATERMAIN
l Gri I-P& 12 ' 111 WATERMAIN
L.F.of WATERMAIN
LF.of WATERMAIN
—� EACH of _g— ' �� GATE VALVES
T EACH of CI GATE VALVES
BACHof GATE VALVES
EACH of FIRE HYDRANT ASSEMBLIES $
(Cast of Fire Hydrants must he listed seryntelyi f 0. 0 (relocation)
(Include Engineering sort Saks T.if applcahle S l�.
^ TOTAL COSTFORWATFR SYSTEM $7,597.00
SANITARY SEWER SYSTEM STORM DRAINAGE SYSTEM:
(avo Sim Type Length Size Type
LF.of SL'WPR MAIN LF.of _ STORM LINE
1 L.F.of SLIVER MAIN L.F.of _ ' STORM I LINE
1 L.F.of SEWER MAIN LF of STORMLWE
1 EA of DIAMETER MANHOIFS FA of STORM INIJTfzDIJnSf
EA of DIAMEITR M.WHom EA of STORM CATOURASW
(Irctutin6 Pngircvirµ rd Sda Tu EA of STORM CATCHBASIN
Trap ossie) $ (1.1"n fvtimmna and Saks T.
TOTAL COST MR SANITARY SIta SYSTEM 1 if New") S
TLTAL COST FOR STORM DRAINAGE SYSTEM $
STREET IMPROVEMENTS: (Including Curb,Gutter,Sidewalk,Asphalt Pavement and Street Lighting)
SIGNALVATION: (Including Eng.Design Costs,City Permit Fees.WA St Sala Tax)
STREET LIGHTING: (Including Eng.Design Costs.City pr mit Fees,WA St Saks Tso)
Pflik zlgnMory name day phare N
(SIGNATURE)
fmnMLOSTDAn DOC17bh (Signatory muat be autnon,d agent
or owner of subject develu nient)
• ` r.x � t"�+µ r �r 3
r xF� 9
W- 22 86
FOR DISTRIBL,AON TO:
k Waler Ullllly �d®I Building Dlvlslon
@I Weslewscer Ullllly u Publlc W,l(s Cons«Inspcclor
Cd Suncce Water Ullllly
Flra PrerenGon
Melnsenanca Scrrlces
u Trinspornallon Syslasns ��—
Po`ojecu IJ�
; hestlrrNi C;A rFrL_ -
Location: igr L)
Anaaam plisse Ilnd copies of: ,y
` �0 PERMIT BILLS OF SALE
Ina RECEIPT COST DATA INVENTORY 4x
a LETTER OF SPECIAL BILLING ® EASEMENT(S)
STUB SERYICEAGREEMENT ® COPY OFAS•BUILT
PRECON NOTES
Elf) PRECON ATTENDEES
DRAINAGE REPORT
MEMO•WATER BRBAKDONN
Elf MAP WITH NEW MA LiS AND YALYES
kD OTHER
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From:
Date:
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Cis"GYY.x"�b„) a! . r ., !•_ >~rd t,. �3»+{r
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I Return Address:
City Clerk's Office
City of Renton
200 Mill Avenue South
Renton,WA 98055-2189
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BILL OF SALE Property Tav Pa ul Number:
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9002
Prom File g:89643 tit�M "onS t Talbot
Addrc
am I�e r
beef? 'ron-i s asngned or retraved Additional remote minters are on page_
Gmmtor(sl: valley Medical Center Grantee(sl: '
1. I. City of Renton,a Municipal Co
2. rporation ?.
! The Craotoq as named above,for,soil in cwsid<nli9a of muWal benefits,hertbv crams,hargeins,selk and delivers to
he franttt.m named about,the following described personal propeny
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/.F &r 1L" ill uH7t aCMAru
5 S'r rAtt ✓A�vES
,j JZr' GRTEVgt✓E$
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By this conveyance,Grantor will warnnl.4 defend the sale hereby made onto the Gno-,a against Aloud curry person
or perwns,rahmnsocver.lawfully darmmg or to Bann the same I'hi.romavance shall bind the heirs.ezeawon.
adnaormm.rs and a>srgm lu e,c
Uy97mulosnn mInh —_— page I
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DEC 0?-97 TILE 03:4b PM DIAMOND 8 CONSTRUCTORS FAX NO. 3607332849 P. 03
_. .___
IN W—nNFSS RFAI',I heramo aetmyi W and ua!the d.y and year u Written below.
0m/ MLkV&Ikt0FAC"0WL6DGMEWr
Newry Scat must be within boa STAW OF WASFVW TON )SS
COUNTY OF KING )
I cmify that l know o:loam ruiaa<IaY cridrace Nat
_ _eitued out instrument and
acknowledged it to he hiAwAhelr free and voluntary act for the uses and purpnms
menuolwd N the aistomom
Notary Public in and for the Stale of Washir^ton
Notary(Paul)
My appointment expires:.
Dated:
stelAlfFMAryVF FOaNOF'. 'J'NOWLEDGMCM -- —
Notary Soil must be within box STATF.OF WASHNGTON )SS
('OUR$Y OF KING )
I certify that l know or lwr a.Wsfacmry cridcncr Nat,_led N _„__
_ sigoed Nis instrm an oath i
staot hds4dhey waslsrxm authoruedt....mne me in:uum.m and
acklmwlcuted it as the- and
of to be the her and vohrowy wI of suds
p"flunies la the uses and purposes mentioned in the instrument.
Notary Puhlie in and for the State of Washington
Nowy(Print)
My appointment expimi:
Dated:
Not"Sell must be within box STATEOPWASHNGION )SS
CUUNTY OF KING I
Onthis _ dryof-_. ,IS___,bnforenw personalty oppeated
known m
Lc of Nr torpN.tiaatias that
cxeeuted Nc within ussndussenL and a.kmwlcdgc the raid outruownl to be Lhe free
and vomnuuy act and deed of said corponuon,fa the uses and purposes therein
memiunrd,and eack an oath skkd that hdrhe wax autbonrzd to eaecut,sxid
msoancm and eul Nc seal aOsxW it it,,ro,.Mtc seal of said cogmruuan.
Notary Poblie in and for the Stale of W ushinl?on --
Notary(Print)— —
My appointment expires:_
—. Dated:
F
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OO POW O£ACKNOWLEDCMEM
Notary Sul must be within box STATE STATE OFF WASHMGTON I SS
COUNTY OF KMG )
I ceni'y that I know or have soisfaclory evidence that
signed this instrument and
acknowledged it to be hi0-Alicts free and voluntary act for the uses and pumoscs
mentioned in the instmmcnl
j Notary Public in and for the Stale of Washington
11 Notary(Print)____
My appointment•xnires:_
Dated'
REIRESEATATIVEIVE£ORMO£ACKNOWLfOGMENT
Notary Seal must be wihin box STATE OF WASHINGTON )SS
I COUNTY OF KING )
s I certify that I know cur have mislactory evidence that t�nm u i n •yk
In• I+�N1r'l�A signed this ina nine oath
stated that hO%haahp waslayta sutho iad to execute the ntsbument In
MOUM1'IR aeanawl aged tuth tend
H. TOJMA p( UA la be roe htt and voluntary act of such
STATE Ole W_$';!h^(Qy pattK/pamu or the tau uryosrs mentioned in the instrument.
H:-CPY PU9:iC GG.
aT cum iiAx UuSREs k-Og-M
No lie in and for a to a oL(pshington
Notary(Print) 077i[I/IN^ OJ t
My appo tment expies: 9
' Dated: P( ,
OR/ORATE£ RAID£ACKNOWLEDGMENT
Notary Sul must be within box STATE OF WASHMGTON )SS
COUNTY OF KMG )
1
On this_ day of ,19 ,before me personally appeared
tt
to me known to
pt the corporation that
exaw<d the within insbumuk art acknowledge the said me utnem to be the free
and voluntary act and deed of said corporation,for the uses and purposes therein
e .t. mentioned,and each on oath It"that hNshe was authorised W uccule said
$ instroment and that the seal affixed is the corporate sul of said corporation.
st,
,e Notary Public in and for the State of Washington
e t{N Notary(Print)
My appointment expires:
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Dated:
TORMSU(CRFCOtIMEASEMENT COCI Page) FORM 03000MWCA .21-v'
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EXHIBIT "A"
PROJECT CLOSING g4 Final Cast Data
FINAL COST DATA AND INVENTORY ••d TnveRt•ry
SUBJECT. B960743 CITY PROJECT NUMBERS: WTR-
Co-Generation Plant WWP
4 vat tg� '-Center SWP
Narne of pmjM T70- _
TI'P
TO. Cit of Renton FROM:
Y CC
%an Review Section r Stree
%anninW8.ddin&1Nbhc Woos Renton . WA 98055
200 Mill Av .South _
Renton.WA 99055 DATE: Derem her' 1997
Per the request of the City of Renton,the following infomlation is furnished concerning final costs for improvements
installed for the above referenced project.
WATER SYSTEM CONbMUCIIUN COSTS:
I.englh Sire Type
64 LC of 8 ' Q_ WATERMAIN
5 19 L.F.of 12 riT WATERMAIN
L.F.of WATERMAIN
LF.of WATERMAIN
—� EACH of GATEVAI.IFS
T— EACHof -2 CI GATE VALVES
EACH of GATE VALVES
EACH of FIRE HYDRANT ASSEMBLIES �S p�.
(Con of For Hydemots mwi-&;iatrd aep. I $1 ,000.00 (relocation)
(Inclu&Engineering aW Sales Tu if appliewe S 601 .-5U—
TOTALCORTFORWATERSYSTEM $7,597,00
SANRARY SEWER SYSIE6li STORM DRAINAGE SYSTEM
Length Sire TYT. Leah Size Type
L.F.of = SMU MAIN LP.of STORM LINE
LF.of SIr MAIN LF.of STORM LIM
L.F.of SEWER MAIN L.F.of STORM LINE.
EA of DIA;—Wim MAN oO s EA of _ ' -- STORM IMETAIVTIFT
EA of DIAARIEt MANIKAMS EA of _ ' STORM CAMIEASPI
(In<ludip 5ryimenng and SJU Tu EA of MRM CATCHBASM
it a;phrabkl i _ (IrthtiN 13gi ,and Saks T.
TOTAL(WTi RSANITARYSIMrRSYSTG/ $ 'IMThc f _S
-- TOTAL M. TMRSTORMDRAINAGESYSIEM S
STREET IMPROVEMENTS. (InRiuding Curb,Ginter,Sidewa A.Asphalt Nwn"I aW Shen Lighting)
SIGNALI7 TON: (ImlWing Eng.Design Cora.City Permil Fees.WA St S•ka Tas)
STREET LIGHTING: (I.I d.ng Fng.I),slgn Cols.City Fertnit Tees,WA St Sales Tas)
9" . L 1%mrcw 25 2sj -5I I
Pn Ignatory narrN Asy photo s
(SIGNAITIRE)
f.aw(MSIDAn DUCYNt (Signatory must be w11u,n1 d agent
or owrlrr of subject devAopmen0
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CITY OF RENTON WATER DEPARTMENT R :
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Pressure Test 6 Purification Test Foan
PROJECT NO. yy /�]. � I r f�
NAME OF PROJECT Cc "tRl is.� At,t,{x Cv de llr;Mt h; 4 CP,,I-e#1- 1
PRESSURE TEST TAKEN of 6 SnrcAR.4 ON Fe /%, / 9 9 7
AT A PRESSURE OF lSO PSI, FOR MIN. - }
TEST ACCEPTED ON M h-7 PURIFICATION TEST TAKEN BY U 'f p ON ZZW/9 7
PURIFICATION TEST RESULTS, SAMPLE 01 PAh`7c� y t
SAMPLE 02
SAMPLE 03
REMARKS:�fOP CF, F 4- 12� F
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CONSTRUCTION REPORT FOR PUBLIC WATER SYSTEM PROJECTS
Effective September 9, 1983 the following Regulation applies: WAC 246-290-040(3)-A construction report
shall be submitted to and accepted by the department within sixty days of completion and prior to use of any
project for which plans and specifications have been approved by the department for projects designed by a
professional engineer. The construction report must be signed by a profession!engineer. The report shall
state in the opinion of the signee whether the project has been constructed in accordance with approved plans i
and specifications and the installation,testing and disinfection of the system were carried out in accordance
with department regulations.
a) If a project is being completed in staged construction,attach a ma and description ofe ` !P p portion of project
being certified as completed as approved an date given below.
b) As future portions of staged construction projects arc completed,each must be certified as required by
\VAC 246-290.040(3).
c) Additional certification forms are available upon request from DOH offices listed below.
City of Renton DOH Water System No. 718t0y
200 Mill Avenue South _
Renton,V.'A 98055 Referendum No.(if any)
PROJECT NAME AND DESCRIPTIVE TITLE: Date Specifications Approved
City of Renton Water System by Department of Health
King County August 18,1993
Renton Project Number WjR 272256 (1229 Comprehensive Wt gyre PI )
Project Title: Vklk4 Medle,l —�o qc N[va-f roN $wtlrlrn4
The undersigned engineer or his authorized agent has inspected the above-described project,whi,h as to
layout,size and type of pipe,valves and materials,reservoir and other designed physical 6ci''ties has been
constructed in accordance with specifications approved by the Secretary,Depart icnt of Health,and in the
opinion of the engineer,the installation,testing and disinfection of the system was carried out in ncordance
with the specifications approved by th ajry.
w
JY r a EngineerEngineer's Seal Seal� 9 �'� f
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.mar vacs t^.•� ,tft�11 3 144�
�= Date
Please return completed form to DOH once checked below:
NW Drinking Water SW Drinking Water Eastern Drinking Water
® Environmental Health ❑ Environmental Health ❑ Environmental Health
1511 Third,Suite 719 Mail Stop 7823 1500 W Fourth,Suite 305
Seattle,WA 981111 Olympia,WA 98504 Spokane,W A 99204
H.D1v1siOMA1MLMES\D0Csnvs.rai ooc
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! c3 CITY OF RENTON
Planning/Building/Puhlic Works Department
III less,Tanner.Mayor Gregg Zimmerman P.E.,Adminisiralor
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(
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March 3, 1997
Bob James
Environmental Health
i 1511 Third Avenue,Suite 719
Seattle,WA 98101 ;
i
SUBJECT: DOH Construction Reports
Dear Mr.James:
Artached we DOH construction reports as required by WAC 246-290-040(3)for the following private
development projects.
e MCDonald's at Renton Village-Grady Way&Shattuck Ave
e Valley Medical-Cogeneration Building-Carr Road&7 albot Road S 'r'+"
Copies of the purity tests and pressure tests for these new water mains are included with each report. If
you have any questions regarding these reports,please ail the at 277-6178.
S ncerely,
Neil Watts,P.E.
Plan Review Supervisor
Development Services Division
An..Annxs
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200 Mill Avenue South-Renton,Washington 98055 -
®naA.oe emmla Aa.i«wam.ww,ro�wa,.wwwl
Lamks Tasting Labw$tCflw,Ina ---
v+oS ��_�..,,.v seam, c:AN10e
WATER BACTERIOLOGICAL ANALYSIS
S"WaODUECTON AW INSTRUCTIONS ON BACK OF GOLDENROD COPY
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(SIPL N__ )
REQUEST POR PROJECT N lat (PPfI )
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To: Technical Services Date / - `' 117
WON --4-7 Gr=k
From. Plan Review/Project Manager PWLIL " r —
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ProjeclNvne '
Description of Projmt: 41c4,. f/ / ,,v e, U ui tad' ) / tA,
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Circle Siu of Waterline: S" 10 �2' Circle One: New or E%t cx/5rf�[
` Circle Size o(Sewerline: g` IC" 12"
CIMIe One: New or Extension - 5,O�
Circle Siu of Stomiline: 12" 15" is' 24" Circle One: New or Extension - Oa%
Address or Street Name(s) N3 co T
DvlpttCon"-tor/O.vner/Cnslc: - J Ai oit!)L C<f �'e 3''' T-
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Check each discipline involved in Pm*t Ltr Dmg N of sheets per discipline
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Approved by TSM Date:
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